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pdfSPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
In order to help the National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we
are reaching out to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy
Act, and we will protect the confidentiality of your responses using procedures we have in place, including reporting all
information in aggregate to avoid identifying information. Only members of the NHTTAC Evaluation Team have access to
information that could identify respondents. If you have any questions about this survey or the evaluation, please contact
[email protected].
Please provide the information below to create an anonymous ID:
______
______
______
Birth Month
(insert just the month
for your date of birth,
example: 08 for August)
First letter of first name
(example: S for Sara)
First letter of your middle name
(example: M for Maria)
T/TA: _______________________________________________________________ DATE(S): _______________________
CONSULTANT FACILITATOR(S): _______________________________________________________________________
NHTTAC COORDINATOR: _____________________________________________________________________________
Please indicate how well the training met each stated objective.
OVERALL OBJECTIVES
Poor
Fair
Good
Excellent
1.
[Insert objective 1].
1
2
3
4
2.
[Insert objective 2].
1
2
3
4
3.
[Insert objective 3].
1
2
3
4
4.
[Insert objective 4].
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2
3
4
5.
[Insert objective 5].
1
2
3
4
6.
Please list any other professional goals you have achieved through this T/TA.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
Please indicate the extent to which you agree or disagree with the following statements.
FACILITATOR 1: ___________________
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
7.
The facilitator demonstrated a comprehensive knowledge of
the subject.
1
2
3
4
NA
8.
The facilitator clearly and logically presented the content.
1
2
3
4
NA
9.
The facilitator responded well to questions and comments.
1
2
3
4
NA
10. The facilitator created a respectful environment for
participants.
1
2
3
4
NA
11. The facilitator encouraged and initiated helpful discussions.
1
2
3
4
NA
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
12. The facilitator demonstrated a comprehensive knowledge of
the subject.
1
2
3
4
NA
13. The facilitator clearly and logically presented the content.
1
2
3
4
NA
14. The facilitator responded well to questions and comments.
1
2
3
4
NA
15. The facilitator created a respectful environment for
participants.
1
2
3
4
NA
16. The facilitator encouraged and initiated helpful discussions.
1
2
3
4
NA
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
17. The T/TA reflected a public health approach to addressing
human trafficking.
1
2
3
4
NA
18. The T/TA helped me identify potential language and cultural
barriers my organization might face in responding to human
trafficking.
1
2
3
4
NA
19. The T/TA was trauma informed.
1
2
3
4
NA
20. The T/TA was survivor informed.
1
2
3
4
NA
21. The T/TA was grounded in a multidisciplinary approach to
addressing human trafficking.
1
2
3
4
NA
22. The T/TA included evidence-based research or promising
practices.
1
2
3
4
NA
23. The T/TA will positively impact my organization’s response
to human trafficking.
1
2
3
4
NA
24. This T/TA met my educational needs.
1
2
3
4
NA
25. This T/TA met my professional needs.
1
2
3
4
NA
26. This T/TA changed [my/my organization’s] attitudes on
trauma-informed approaches to addressing trafficking
1
2
3
4
NA
27. This T/TA increased my professional networking or peer
support
1
2
3
4
28. This T/TA increased knowledge to inform a human
trafficking public health response.
1
2
3
4
FACILITATOR 2: ___________________
OVERALL FEEDBACK
NA
NA
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
29. [insert T/TA activity objective].
1
2
3
4
NA
30. [insert T/TA activity objective].
1
2
3
4
NA
31. [insert T/TA activity objective].
1
2
3
4
NA
32. [insert T/TA activity objective].
1
2
3
4
NA
33. [insert T/TA activity objective].
1
2
3
4
NA
34. [insert T/TA activity objective].
1
2
3
4
NA
35. [insert T/TA activity objective].
1
2
3
4
NA
36. [insert T/TA activity objective].
1
2
3
4
NA
37. [insert T/TA activity objective]
1
2
3
4
NA
38. [insert T/TA activity objective].
1
2
3
4
NA
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
39. NHTTAC was responsive to my questions and needs.
1
2
3
4
NA
40. NHTTAC was effective in identifying an appropriate grantee
to help with our request.
1
2
3
4
NA
41. NHTTAC staff was detail-oriented and thorough in the
planning of this T/TA.
1
2
3
4
NA
42. NHTTAC was timely throughout the planning process.
1
2
3
4
NA
43. The planning for this T/TA was well coordinated.
1
2
3
4
NA
T/TA ACTIVITY: ________________________
PLANNING
44. Please rate the overall quality of this T/TA.
1
2
3
4
Poor
Fair
Good
Excellent
45. How satisfied were you with your overall NHTTAC experience?
1
2
3
4
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
3
Met My
Expectations
4
Exceeded My
Expectations
46. How well did this assistance meet your expectations?
1
Far Below My
Expectations
2
Did Not Meet My
Expectations
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
47. How responsive was NHTTAC to your needs following the T/TA?
1
Completely
Unresponsive
2
3
4
Unresponsive
Responsive
Very Responsive
□ Yes
48. Would you recommend NHTTAC to others to receive T/TA?
□ No
49. What are three things you plan to do as a result of this T/TA?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
50. Following this T/TA, how prepared do you feel to take steps toward addressing human trafficking in your organization?
1
2
3
4
Not At All Prepared
Somewhat Prepared
Mostly Prepared
Completely Prepared
51. What could NHTTAC do in the future to enhance your level of preparedness during this type of T/TA?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
52. What could NHTTAC do in the future to enhance your level of preparedness following this type of T/TA?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
53. What aspects of the T/TA were most helpful and why?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
54. What could NHTTAC do differently to improve similar T/TA requests in the future?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
55. Do you have any other comments or suggestions?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
56. Which of the following best describes the organization in which you work? (Mark all that apply.)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Academic Institution
Anti-trafficking organization
Business/For-profit organization
Coalition/Multidisciplinary team/Task force
Federal government
Faith-based organization
State and local government
Nonprofit/Community-based organization
OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/Worker advocacy organization
Victim service provider
Other, please specify: _____________________
57. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
58. Which of the following best describes your professional capacity or types of services you provide? (Mark all that
apply.)
Behavioral health professional (e.g., psychologist,
Legal (e.g., immigration, civil and/or rights-based
psychiatrist, mental health/substance use counselor)
attorney and/or paralegal, clinic)
Child welfare (e.g., state agency staff, child welfare
Public health (e.g., licensure board, health
contractor, nonprofit personnel)
department staff, health care executive, community
health workers)
Corrections-based services (e.g., parole, probation)
Social worker (e.g., case manager, school
Criminal justice (e.g., law enforcement, prosecutor,
counselor, supervisor, administrator)
probation, court, forensic interviewer)
Survivor empowerment, mentoring, or peer to peer
Educator (e.g., teacher, professor, school
Violence prevention (e.g., Child abuse and neglect;
administrator)
elder abuse; domestic violence, sexual violence,
Health care (e.g., physician, physician assistant,
youth violence)
nurse practitioner, dentist, nurse, pharmacist)
Other (please specify):
Housing (e.g., case worker, shelter director, public
_______________________________
housing authority agencies)
59. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years
□ 3 to 5 years
□ 6 to 10 years
□ More than 10 years
60. Which of the following best describes your primary role in your current position?
□ Direct delivery/frontline staff
□ Management
□ Other (please specify): ____________
□ Consultant/Trainer
□ Volunteer
□ Peer Educator
□ Administration
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
61. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at risk
of trafficking, or has been trafficked?
1
2
3
4
Never
Occasionally
Frequently
Daily
62. Which of the following best describes your geographic population? (Mark all that apply.)
□
□
□
□
National
State (please specify): ______________
Tribal
International (please specify country):
_________________________________
□ Local
□ Urban
□ Rural
□ Suburban
63. Please select any of the following populations you currently work with in a professional capacity (Mark all that apply.)
□
□
□
□
□
Human trafficking
□ Commercial sexual exploitation of
children
□ Sex trafficking
□ Adults
□ Minors
□ Labor trafficking
□ Adults
□ Minors
Children/youth
□ Out of home/Foster care/Kinship care
□ Juvenile justice
□ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
□
□
□
□
□
□
□
□
□
Lesbian, gay, bisexual, transgender, and
questioning
Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaii or other Pacific Islander
□ White
□ Hispanic or Latino ethnicity
History of substance use
Domestic and dating violence
Gang-related crime
Sexual abuse/Violence
Other (Please specify): __________________
64. What is your race? (Mark all that apply.)
□
□
□
□
□
□
American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify): _______________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or additional
suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
65. What is your ethnicity? (Mark all that apply.)
□
□
□
Hispanic or Latino
Middle Eastern or North African
Other (please specify): ________________________________________
66. What is your gender? (Mark all that apply.)
□
□
□
□
Male
Female
Transgender
Other (please specify): ________________________________________
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or additional
suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
| File Type | application/pdf |
| Author | Field, Michael |
| File Modified | 2019-11-01 |
| File Created | 2019-11-01 |